Objective To describe the translation and cultural adaptation of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire into Brazilian Portuguese, and verifies the reliability and validity of this new version.Methods A cross-cultural adaptation of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire was performed using the following steps: translation, back-translation, committee review, and pre-testing phase (50 subjects). The psychometric properties were evaluated by application of the questionnaire to 102 patients. Reliability was assessed by homogeneity and stability of measures. The criterion-related validity was tested by comparing scores of Japanese Orthopaedic Association Back Pain Evaluation Questionnaire to Oswestry and Medical Outcomes Study 36 - Item Short questionnaires.Results Excellent internal consistency was found in both test (Cronbach’s α of 0.90) and re-test (Cronbach’s α of 0.91). The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire showed good reliability and the correlations ranged from reasonable (0.64) to very good (r=0.91).Conclusion The Brazilian Portuguese version of Medical Outcomes Study 36 - Item Short was easy to apply and understand. The questionnaire had a great impact on assessment and multidimensional care of patients with low back pain.

Resumo Objetivo Avaliar a capacidade da artrodese tríplice de aliviar as principais queixas dos pacientes que apresentam pé plano adquirido do adulto (PPAA): 1) dor incapacitante localizada no médio e retropé; 2) deformidades marcadas pelo colapso do arco medial, valgo, abdução e supinação. Método Avaliamos 17 pacientes (20 pés) portadores de PPAA em estado avançado que foram submetidos à correção cirúrgica pela artrodese tríplice modelante. A média de idade dos pacientes no momento da cirurgia foi de 62 anos (variação de 38 a 79 anos), e o tempo médio de seguimento foi de 43 meses (variação de 18 a 84 meses). Utilizamos critérios clínicos empregando a escala visual analógica da dor (EVAD) e a escala funcional da American Orthopaedic Foot and Ankle Society (AOFAS, na sigla em inglês) do retropé para avaliar a eficácia da cirurgia. Resultados A dor residual mensurada pela EVAD foi de três pontos, em média. Observamos incremento médio de 23% nos valores da escala AOFAS do retropé após o tratamento cirúrgico. A correção das deformidades foi satisfatória em 10 de 20 pés; parcialmente satisfatória em 4 de 20 pés; parcialmente insatisfatória em 5 de 20 pés; e insatisfatória em 1 de 20 pés. Conclusão Apesar da artrodese tríplice modelante indicada no tratamento do PPAA em estágio avançado apresentar alto índice de consolidação óssea, a correção incompleta das deformidades pré-existentes e a persistência de dor residual contribuíram para a elevada taxa de decepção dos pacientes com o resultado da cirurgia.

Introduction: Charcot arthropathy can lead to joint destruction and often causes ulcers at sites of bony prominences. In the ankle, it causes instability that limits gait and makes it difficult for patients to wear shoes or orthoses. This was a retrospective study describing cases of Charcot arthropathy of the ankle treated at our institution from 1997 to 2017. Methods: Over the study period, we treated 252 patients with Charcot arthropathy. Of these patients, 27 presented the disease exclusively in the ankle. The selected cases were unilateral; 17 of the patients were men, and the mean age was 55 years. Nine patients were treated conservatively, and 18 were treated surgically to stabilize the ankle (including the hindfoot, if necessary). During surgery, different fixation methods were used depending on the presence or absence of ulcer at the time of the intervention. At the end of the treatment, we assessed the patient’s ability to wear shoes or orthoses for walking, the stability of the ankle joint and, in surgical cases, union. We considered a good outcome when the patient was able to walk wearing shoes or orthoses, and the limb was stable; an acceptable outcome when the limb was unstable, but the patient adapted to orthoses; and a poor outcome when the patient was unable to walk, and the ankle was unstable or amputated. Results: Nine patients underwent conservative treatment using total contact casting at the initial phase of the disease, followed by orthosis after union. Of these patients, the outcome was poor for 5, good for 3 and acceptable for 1. Eighteen patients underwent reconstructive surgery; 12 patients had a good outcome; 2 patients underwent amputation, and 4 patients had unsuccessful surgeries. Conclusion: Charcot arthropathy of the ankle causes considerable instability. Conservative treatment of the disease fails to provide good outcomes, and the patients who underwent reconstructive surgery had the best functional and clinical evaluations.

Introduction: Congenital distal tibiofibular diastasis is an extremely rare entity of unknown etiology that compromises the feet and ankles with different degrees of deformity, although in general, the feet show equinovarus deformity, and the talus is proximally dislocated due to the separation of the distal tibial and fibular epiphyses. There are few reports of this disorder in the literature, and most describe cases that ultimately lead to limb amputation. We present the cases of 2 patients treated from birth to skeletal maturity. Methods: Two female patients with clubfoot at birth were diagnosed with congenital distal tibiofibular diastasis. One of them had the deformity of the right foot, and the other had deformity of both limbs. Both patients underwent early distal tibiofibular arthrodesis and serial stretching of the compromised feet and legs. Results: After 20 years of clinical follow-up and after reaching skeletal maturity, both patients had plantigrade feet without significant shortening of the lower limbs or pain, and both performed activities of daily living without restrictions, wearing conventional shoes. Conclusion: Early distal tibiofibular arthrodesis followed by limb stretching was effective for treating congenital distal tibiofibular diastasis and is a good alternative to amputation, which is indicated in the literature.